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When you have been trying to become parents for a for a long time, IVF can come as a beacon of hope. It has been a path to parenthood for many couples across the globe. Of the couples who have undergone an IVF cycle, most would have been successful, but there would be a few who would have faced a failed treatment.

Dr Anil Chittake, Director and IVF Specialist, EmBrio IVF Centre, Baner, Pune
“In these situations, couples generally go through a roller coaster of emotions – anger, frustration, hopelessness and despair and making one unsure of what should they do next,” says Dr Anil Chittake, Director and IVF Specialist, EmBrio IVF Centre, Baner, Pune.

Let’s take a peek into the success factors of IVF before understanding the next steps of a failed IVF

How Successful Is IVF And What Is The Success Percentage?

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“The success ratio rate for IVF depends on the age of the woman, cause of infertility, years of infertility, type of embryo transfer, quality of the sperm and whether self-eggs or donor eggs were used,” informs Dr Chittake. He says that the success rate is higher when frozen embryos are used as opposed to fresh embryos. Success is higher in younger women, so even when a woman has an embryo transfer, say in her 40s with embryos that were created when she was in her 30s, her chance of success is that of a woman in her 30s. Frozen cycles tend to have a higher success rate as the embryos that survive the thawing process will be more robust, resulting in higher chances of achieving a pregnancy. Donor eggs likewise come from a younger donor who is medically fit and hence tends to give better success rates. Better the sperm quality better the success rate.

Success in IVF is measured in various parameters for audit purposes. The fertilisation rate, implantation rate, clinical pregnancy rate, take home baby rate etc. Of significance is the live birth rate as this is the chance that any couple having treatment will take a baby home.

Irrespective of the age of the patient, a live birth rate of around 30 per cent is considered as gold standard around the world.

What Really Happens When One Has A Failed IVF Cycle?

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A failed IVF cycle doesn’t mean you should not try again – there is still hope
“We have to understand that the probability of a pregnancy after one embryo transfer is only about 40 to 50 per cent, so we need to look at the cumulative pregnancy rate which is approximately 87.5 per cent after three transfers, which is a common finding,” Dr Ruhi Yasmin, Director – Metro IVF, Darbhanga, Bihar, says. 

Dr Ruhi Yasmin, Director – Metro IVF, Darbhanga, Bihar

Also, one of the most common reasons is the age of the woman. As a woman grows older, her body produces fewer eggs and the quality of her eggs deteriorates as well. This number and quality begin to decline when a woman reaches her 30s.There could be other factors at play too, like weight gain, unhealthy lifestyle, poor uterus lining, and/or abnormalities in the interaction between endometrium and embryo.

Experts advise that in such a situation, a couple should support each other while grieving over emotional as well as financial trauma. They should take a break to relax. It is critical to not lose hope as for many couples, their family and friends are involved in this process too. Everyone must understand that one failed cycle doesn’t mean that the next one won’t succeed too.

What Next?

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Have a detailed discussion with your fertility doctor to understand why your first cycle failed to begin with. It is important to know whether the causes are recurrent – and if they can be corrected – and what modifications need to be done before and during the second IVF cycle.

The specialist may either suggest trying the same cycle all over again or additional technologies or medical adjustments can be made like suggested below:
• Different medication protocols
• Genetic screening like PGD/PGS
• Immunotherapy
• Adding in ICSI
• Assisted hatching
• Testing the chromosomal make-up of the couple (karyotyping). The signs of genital TB must be looked for carefully

Apart from understanding the causes and learning how to optimise the success of your second attempt, it’s also important to discuss realistic expectations with your doctor and know how likely you are to get pregnant after your next cycle.

In The Next Attamept…

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While going in for a second IVF attempt might seem like a no-brainer one must keep these three things in mind:
1. Whether or not there are clinical indications for another IVF cycle
2. Your mental and emotional preparedness
3. Financial implications of undergoing another IVF procedure

Yes, You Have More Than Just Two Chances

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When it comes to IVF, one must also know that repetition is the key to success – so one can
really have to look at that cumulative number of 87.5% at the end of three embryo transfers,” Dr Divyashree elucidates.

That said, there are many factors that contribute to how many IVF cycles you as a couple are eligible for. “For repeated embryo transfers, we need to have a good number of embryos resulting from one egg pick-up,” she says, adding: “If we have a good number of embryos from a good number of eggs obtained from a single IVF, then even one cycle can be enough.”

So from a purely medical point of view, you can have as many IVF cycles as the number of viable embryos. There is no upper limit to this number, says Dr Divyashree, stressing that perseverance, mental fortitude, and financial conditions of the couple are the driving factors for more and more cycles.

Before You Go In For The Next Cycle, Avoid These

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There is no denying that failure with IVF can be heart-wrenching. But if you have made the brave decision of going in for another cycle, then it’s important to get things right and avoid some common mistakes, like:

1. Don’t Google too much about IVF: Delving deep into the world of the internet to research about IVF is understandable. But being obsessed with what Google says about success rates, hacks to get pregnant and so on, isn’t going to help. Says Dr Divyashree: “Google cannot replace a doctor. It can, however, give you unwanted information about your medical condition, giving rise to anxiety. And anxiety is not good if you want IVF success.”

2. Don’t take to the bed after an IVF cycle: “Taking bed rest after an IVF procedure is totally unwarranted for,” explains Dr Divyashree. You see, when you move about, you give all your organs a good blood supply. This blood supply is important for the uterus too, especially for embryo implantation. “It is very important to be physically active after an IVF cycle. In fact, contrary to popular belief complete bed rest after a cycle can lead to life-threatening complications like blood clots and embolism,” she adds.

3. Choose a doctor and clinic wisely: A failed IVF cycle might leave you doubting your doctor and clinic’s credentials, wanting a switch. And there’s nothing wrong with that, as long as you choose someone who has the desired experience. “Choose a doctor who has the specified qualifications and experience with infertility and is associated with a reputed IVF clinic with good success rates,” says Dr Divyashree. If you do decide to switch clinics and doctors, carry all your reports with you because it will have a treasure trove of information for your second IVF.

In The End, Remember…

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In the four decades that IVF has been around, science has jumped ahead by leaps and bounds. So, there is absolutely nothing that you need to be worried about. “IVF is totally safe and there is no reason to panic. Millions of babies have been born throughout the world through IVF, and they are as normal as babies born naturally. You just need to have realistic expectations and consult your doctor about the next steps for you,” Dr Divyashree concludes.

Reports of Lina Alvarez giving, who is a doctor herself, giving birth to a healthy child after IVF at the age of 62 years created controversies, fostered dreams and busted several myths about becoming a mother at an advanced age. In 2016, 72-years old Daljinder Kaur, who is considered to be the oldest women in the world to give birth after IVF prompting hues and cries from the Indian Medical Council for an age limit of the recipients of fertility treatments.

In Britain, women above 42 years of age aren’t eligible to receive fertility treatments including IVF, at NHS. However, there are cases where women seek IVF treatments in private, so where does the controversy surrounding IVF in older couples stem from? Kshitiz Murdia, Medical Director, Indira IVF busts five myths regarding IVF in older women.

Myth: Pregnancy in older women always lead to complications before and during birth.

Reality: Over the years, doctors have spoken extensively about the complications that arise in older women during pregnancy. Older mothers tend to suffer more from high blood pressure, pre-term labour and diabetes than their younger counterpart during pregnancy. However, according to a study by Reichman et al, published in the American Journal of Obstetrics and Gynaecology, there is not enough evidence to link advanced maternal age to preterm delivery. As per another study published in the Maternal and Child Health Journal (Cavazos-Rehg et al), complications during pregnancy and delivery were highest among women between the ages of 11 and 18.

After Proper medical evaluation before IVF, it’s possible to find out high-risk patients among older women. And by offering IVF only to low-risk patients reduces the risk of complication that may happen during the antenatal period. Moreover, women of every age should consider these challenges before and during pregnancy, but there is not enough scientific evidence that suggests that these health concerns only affect older women going through IVF.

Myth: Pregnancy in older women harms the child.

Reality: Natural pregnancy in older women, although rare, increases the chances of the foetus developing chromosomal disorders including Down’s syndrome. During IVF medical professionals screen each embryo for possible Genetic abnormalities via Pre-Implantation Genetic Screening, and only implant the healthiest one(s) in the mother’s uterus. These screening tests and diagnostic tests can detect chromosomal abnormalities beyond Down’s syndrome

According to a 2019 study published in the Acta Obstetricia et Gynecologica Scandinavica, the health of an embryo depends upon the health of the mother, which, in many cases, is independent of a woman’s age. There are options where an older woman can choose to go through IVF with the eggs from a younger woman. In such instances, the health risks of the foetus due to chromosomal abnormalities can be nullified and can achieve genetically normal pregnancy like a younger woman.

Myth: IVF isn’t successful in older women.

Reality: It is a popular belief that IVF in older women is likely to fail. It may come from the fact that older women are less likely to become pregnant without fertility treatments. It is true that when older women use their own eggs (ova) the chances of successful pregnancies diminish drastically. However, when women receive donor eggs, the success rate increases drastically, as pregnancy rate is inversely related to mothers age if; IVF is done with self-egg.

An older woman can have the same success rate as a younger woman irrespective of her ethnicity as long as the donor eggs come from a young and healthy woman. It also reduces the chances of the baby having chromosomal disorders.

Myth: Being older parents can be harmful to the child.

Reality: The average life expectancy of men and women in India is on the rise. So, leaving a young child fatherless or motherless at a tender age is only a distant possibility. Some believe that older women are unable to meet the physical demands of motherhood. However, that is also true for younger women due to physiological and psychological limitations.

In many countries, especially in India, children receive attention and care from their grandparents. These children typically thrive in academics and beyond. Age is not a bar in motherhood and the attitude of people towards older women becoming mothers through IVF is changing rapidly.

Myth: Older women can’t bear children using their own ova.

Reality: Earlier, it was almost impossible to even think that women above 35 years of age could become pregnant, but IVF is changing that notion. Women’s of advanced age having low egg count can now fulfil her dreams of having own biological child, thanks to newer Stimulation protocols, Cryopreservation & PGD technology.

Now, the doctors are considering using healthy frozen ovum for IVF in older women. This is how it can work. A woman in her early or late 20s can choose to have her ova aspirated and frozen. Later in life, maybe after 35 or even 40 years of age, she can choose to undergo IVF. The doctor can use the frozen ova for subsequent fertilization and implantation. This reduces the risks of implanting an ovum with chromosomal abnormalities due to degrading DNA in older eggs. And it gives a chance to older women to become mothers using their own eggs.

Becoming a mother is a choice. While one should always consider her health before opting for IVF, age should not be a limiting factor.